Session Information
Title: Pediatric Rheumatology - Clinical and Therapeutic Aspects: Pediatric Systemic Lupus Erythematosus
Session Type: Abstract Submissions (ACR)
Background/Purpose: Pregnant women with SLE have increased risk of adverse outcomes including lupus flare, spontaneous abortion, preeclampsia/eclampsia, premature birth and maternal death, but pregnancy outcomes among adolescents and young women with SLE have not been well-explored. Our goal was to compare pregnancy outcomes among adolescents and young women with and without SLE, and to identify associated risk factors.
Methods: We studied the 2000-2011 Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality. The NIS contains annual discharge data from all-payer hospital stays from about 1,000 nationwide hospitals, to approximate a 20% stratified sample of U.S. community hospitals. Hospitalizations of individuals age 21 or less with ICD-9 discharge diagnoses associated with pregnancy were included (delivery, liveborn, abortion, ectopic pregnancy, or intrauterine death). SLE hospitalizations were identified by a 710.0 ICD-9 code. After applying sampling weights, unadjusted odds ratios to estimate the risk of adverse pregnancy outcomes among individuals with and without SLE were calculated. Multi-variate logistic regression was performed to examine the independent effect of age, race, and socio-economic status on pre-eclampsia/eclampsia.
Results: 9,125,224 estimated hospitalizations were included in the analysis, of which 4,142 had SLE. Hospitalized women with SLE were slightly older (mean age 19.4 with range 14-21 vs.19 with range 8-21), more likely to be black (34% v. 21%), more likely to carry a discharge diagnosis of nephritis (11% v. 0.02%) or aPL (2.7% v. 0.1%), and more likely to undergo hemodialysis (0.35% v. 0.0%), all p<0.0001. Socioeconomic status represented by median household income quartiles for patient zip codes were not different across groups.
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Table 1: Unadjusted weighted estimates of outcomes of unique pregnancies by hospital discharge data in those with and without SLE
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Outcome
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SLE N = 4,142
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Non-SLE N = 9,121,082
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P*
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OR (95%CI) +
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N (%) unless noted
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Maternal Outcomes |
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Pre-eclampsia and Eclampsia
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657 (16) |
417,676 (4.6) |
<0.0001 |
3.9 (3.3 4.7) |
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Death during hospitalization
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15 (0.37) |
490 (0.005) |
<0.0001 |
69.7 (22.6 214.6) |
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Fetal Outcomes |
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Preterm |
843 (20) |
736,665 (8.1) |
<0.0001 |
2.9 (2.5 3.4) |
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Low birth weight or fetal growth retardation
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0 (0) |
20 (0) |
0.97 |
1 (0.0004 0.0005) |
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Spontaneous abortion or Intrauterine death
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179 (4.3) |
99,426 (1.1) |
<0.0001 |
4.1 (2.9 5.8) |
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Induced abortion
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90 (2.2) |
11,749 (0.13) |
<0.0001 |
17.2 (10.4 28.3) |
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Ectopic pregnancy
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²10 (²0.24)⌃ |
30,293 (0.3) |
0.61 |
0.7 (0.17 2.78) |
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Congenital Anomalies
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58 (1.4) |
29,185 (0.32) |
<0.0001 |
4.4 (2.5 7.8) |
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* CHI2 Analysis + Unadjusted logistic regression ⌃Unable to report cell sizes less than or equal to 10, per HCUP data use regulations. |
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Conclusion: This large national dataset demonstrated increased risk of pre-eclampsia/eclampsia, maternal death, preterm labor, spontaneous and induced abortion, and congenital anomalies in pregnant adolescents and young women with SLE compared to those without SLE. This is similar to previous findings in the literature regarding adult women with SLE. Disease duration and activity, medication exposure and age of SLE onset for the study population are not known. Additional analyses are planned to further explore outcomes with multivariate modeling and to characterize risk factors associated with poor pregnancy outcomes among adolescents and young women with SLE.
Disclosure:
N. Ling,
None;
I. E. Allen,
None;
E. F. Lawson,
None;
E. von Scheven,
None.
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